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State AGs Ask CMS to Suspend Nursing Home Rating System

September 30th, 2009

The attorneys general of 30 states have sent a letter to the Centers for Medicare and Medicaid Services (CMS) asking it to suspend and revise its newly implemented "Five-Star" rating system for nursing homes. The attorneys general object to the fact that the rating system does not allow consumers to compare nursing homes across state lines. CMS has responded by defending the system.

The rating system, which was launched in December 2008, gives nursing homes a rating of between one and five stars. A five-star designation means the facility ranks "much above average" compared to other facilities in its state, while a one-star designation means that a facility ranks "much below average" in the state. The rankings, which are updated monthly, are based on a nursing home's performance in three areas: quality measures, nurse staffing levels and health inspection reports.

Daniel N. Steven, LLC

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In effect, the rating system grades nursing homes on a curve within each state. The letter from the attorneys general argues instead for "an absolute national standard" against which to measure nursing homes.

CMS responded that the system provides valuable information to consumers and was developed with input from nursing homes. The consumer group NCCHNR (formerly the National Citizens' Coalition for Nursing Home Reform) has also objected to the letter, arguing the ratings are the best system currently available for evaluating nursing homes and describing the letter as part of an "industry-led campaign to eliminate an important consumer information source." Nursing homes have objected to the rating system since it was launched.